1) The hallmarks of low functioning BPD sufferers:

They are also likely, sometimes, to be hospitalized in a psychiatric ward, either voluntarily or under Section, as an inpatient, or, on other occasions, they may make use of the hospital’s services as an outpatient.

Often, too, low functioning BPD sufferers will have co-morbid conditions such as anorexia, bulimia and bipolar disorder (which used to be referred to as manic depression).

Also, their day-to-day functioning is likely to be significantly impaired. For example, they may find it very hard to hold down a job or even to work at all.

Low functioning BPD sufferers also tend to be highly dependent on family members for help and support to the extent that they (the BPD sufferer’s family) may experience ‘compassion fatigue’ and feel overwhelmed, unable to cope, inadequate and impotent.

2) The hallmarks of high functioning BPD sufferers:

High functioning BPD sufferers often excessively blame others for their difficulties (which is not the same as saying they are always wrong to do so) and may, too, have great difficulty suppressing intense feelings of anger (for example, they may frequently fly into fits of rage, even over things that others may regard as relatively trivial).

Often, too, they resist advice to seek psychiatric help, regarding such advice as a slur on their character and claiming that there is absolutely nothing psychologically wrong with them (often because they lack insight into their condition). As a consequence of this, they may remain unknown to psychiatric services for their entire lifetimes).

Also, they may (co-morbidly) suffer from narcissistic personality disorder and regard seeking professional help from psychiatric services ‘beneath their dignity.’

Because of their relatively high level of functioning, they may be able to hold down a job and even excel at it.

Their family members often become highly frustrated and despairing that their relative with BPD fails to acknowledge that they clearly have a psychological problem requiring professional intervention.

3) BPD Sufferers Who Suffer A Mixture Of The Above Two Sets Of Symptoms:

I have looked in detail at the association between childhood trauma and its role in contributing to the development of Borderline Personality Disorder (BPD) elsewhere on this site, and, in this article, I intend to examine two different types of individuals with BPD: LOW FUNCTIONING and HIGH FUNCTIONING.

Just as there are high functioning and low functioning alcoholics, so, too, are there high and low functioning individuals who suffer from the serious psychiatric condition known as Borderline Personality Disorder (BPD). In other words, some people with BPD cope relatively well with the usual demands of day to day living (such as having a successful career, for example) whilst others are severely impaired in relationship to their ability to cope with everyday and so may need special care and financial support from the government.

Of course, many people with BPD do not neatly fit into one category or the other, but fall somewhere in between (for example, they may be high functioning at times, but low functioning when subjected to significant stress).

Characteristics Of Low Functioning BPD Sufferers:

1) Might be unable work or have their capacity to work severely restricted by their condition.

3) May frequently require psychiatric, in-patient, hospital care (by both voluntary and involuntary admissions). Such hospitalisations may, frequently, be due to attempted suicide or a preoccupation with/intention to carry out suicide.

4) May seem to stagger from crisis to crisis ; no sooner is one over, another takes its place.

5) Prone to a variety of self-destructive behaviours (drinking very heavily, binging on drugs, gambling, getting into fights and unnecessary confrontations, self-harming – by means of cutting self with razor blades/burning self with cigarettes and other methods – or even suicide attempts. Such self-destructive behaviour is particularly likely to occur during periods of significant stress, particularly if s/he has no, or limited, social/familial support.

Above: The private and public faces of some of those suffering from BPD may be very different (see point 4, below).

Characteristics Of High Functioning BPD Sufferers:

1) Probably likely to work most of the time – indeed, may have successful career.

2) Likely to appear, for want of a better phrase, ‘pretty normal’ to those with whom s/he is not intimately connected.

3) Is likely to have little or no insight into his/her condition due to unconsciously employing the psychological defence of complete, impregnable denial. Due to this, whenever in conflict with others, will invariably view themselves as absolutely in the right and the other as entirely in the wrong, irrespective of what any objective and rational analysis of the conflict may suggest.

4) As implied above, tend to only show the symptoms of their condition to those they know intimately (eg family members. partners). These symptoms may include explosive rage, excessive and inappropriate criticism, vitriolic verbal abuse, threats of violence or actual violence.

5) Tend not to seek psychiatric help due to their psychological state of denial (see point 3, above). Researchers have therefore termed such individuals ‘invisible’. In other words, they cannot usually be included in research studies (as the researchers are unaware of their existence) and, also, are not included in the statistics which must inevitably lead us to the supposition that estimates of the number of individuals suffering from BPD are likely to be significantly too low.

Resources:

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